scholarly journals The PAxpress™ is an effective ventilatory device but has an 18% failure rate for flexible lightwandguided tracheal intubation in anesthetized paralyzed patients

2003 ◽  
Vol 50 (5) ◽  
pp. 495-500 ◽  
Author(s):  
Vasilios Dimitriou ◽  
Gregory S. Voyagis ◽  
Christos Iatrou ◽  
Joseph Brimacombe
Keyword(s):  
Tracheal Intubation ◽  
Failure Rate ◽  
Ventilatory Device

Comparative Evaluation of Performance of Videolaryngoscope vs Fastrach Intubating Laryngeal Mask Airway

2017 ◽  
Vol 2 (1) ◽  
pp. 1-7
Author(s):  
Vartika Singh ◽  
Vartika Vinay ◽  
Reehan Ahmed
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Comparative Evaluation ◽  
Video Laryngoscope ◽  
Laryngeal Mask ◽  
Independent Observer ◽  
Evaluation Of Performance ◽  
Intubating Laryngeal Mask Airway ◽  
Ventilatory Device

ABSTRACT Introduction This prospective randomized study aimed to compare the effectiveness of the intubating laryngeal mask airway (ILMA) with the King Vision Video laryngoscope in aiding endotracheal intubation in Asian patients with normal airway. King Vision Video laryngoscope is a two-piece design. It has a reusable monitor that attaches to disposable blades. The ILMA is a device specifically designed to be an effective ventilatory device and blind intubating guide in patients with normal and abnormal airways. Materials and methods After ethics committee approval and obtaining patient's written informed consent, 60 American Society of Anesthesiologists grade I and II adult patients undergoing elective surgery requiring intubation were randomly allocated into either the ILMA group (Group L) or the King Vision Video laryngoscope group (Group V). • Thorough preanesthetic checkup was done. Patient was premedicated. Induction was done with propofol 2.5 mg/kg and succinylcholine 1.5 mg/kg. In Group L, ILMA was inserted using a single-handed rotational technique. In the King Vision Video laryngoscope group, intubation was done with videolaryngoscope. Placement was confirmed with auscultation and capnography. • An independent observer recorded the following: – Time taken for successful intubation – Success or failure of the tracheal intubation – Number of attempts needed for successful tracheal intubation – Complication associated with tracheal intubation: bleeding or postoperative sore throat – Hemodynamic response to intubation Results and conclusion King Vision Video laryngoscope is the more effective technique in aiding endotracheal intubation in patients with normal airways. How to cite this article Hanjura S, Agrawal AP, Agrawal M, Singh V, Vinay V, Ahmed R. Comparative Evaluation of Performance of Videolaryngoscope vs Fastrach Intubating Laryngeal Mask Airway. Int J Adv Integ Med Sci 2017;2(1):1-7.

Flexible Lightwand–guided Tracheal Intubation with the Intubating Laryngeal Mask Fastrach  TMin Adults after Unpredicted Failed Laryngoscope-guided Tracheal Intubation

2002 ◽  
Vol 96 (2) ◽  
pp. 296-299 ◽  
Author(s):  
Vasilios Dimitriou ◽  
Gregory S. Voyagis ◽  
Joseph R. Brimacombe
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Median Number ◽  
Airway Device ◽  
Laryngeal Mask ◽  
Successful Intubation ◽  
Inclusion Criteria ◽  
The Third ◽  
Intubating Laryngeal Mask Airway ◽  
Ventilatory Device

Background The authors determined the efficacy of using the intubating laryngeal mask airway Fastrach (ILM) as a ventilatory device and aid to flexible lightwand-guided tracheal intubation in patients with unpredicted failed laryngoscope-guided tracheal intubation when managed by experienced anesthetists. Methods During a 27-month period, 16 experienced anesthetists agreed to use the ILM as an airway device and airway intubator in patients (aged > 18 yr) with predicted normal airways who were subsequently found to be difficult to intubate (three failed attempts at laryngoscopy). Intubation via the ILM was performed with a flexible lightwand. The number of attempts at ILM placement, the number of adjusting maneuvers, the number of attempts at tracheal intubation via the ILM,and any episodes of hypoxia (oxygen saturation < 90%) were recorded. Results Forty-four of 11,621 patients (0.4%) met the inclusion criteria. ILM insertion and ventilation was successful at the first attempt in 40 of 44 patients (91%) and at the second attempt in 4 of 44 (9%). Flexible lightwand-guided tracheal intubation via the ILM was successful in 38 of 44 patients (86%) at the first attempt, 3 of 44 (7%) at the second attempt, 2 of 44 (5%) at the third to fifth attempts, and failed in 1 of 44 (2%). The median number of adjusting maneuvers before successful intubation was 1 (range, 0-4). Hypoxia occurred in 5 patients before ILM insertion (range, 52-82%), but none after ILM insertion. No patient developed hypoxia during or after intubation via the ILM. Conclusion The ILM is an effective ventilatory device and aid to flexible lightwand-guided tracheal intubation in adult patients with predicted normal airways in whom laryngoscope-guided tracheal intubation subsequently fails when managed by experienced anesthetists.

The Laryngeal Mask Airway ProSeal™ as a Temporary Ventilatory Device in Grossly and Morbidly Obese Patients Before Laryngoscope-Guided Tracheal Intubation

2002 ◽  
Vol 94 (3) ◽  
pp. 737-740 ◽  
Author(s):  
Christian Keller ◽  
Joseph Brimacombe ◽  
Axel Kleinsasser ◽  
Lawrence Brimacombe
Keyword(s):  
Laryngeal Mask Airway ◽  
Tracheal Intubation ◽  
Laryngeal Mask ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Laryngeal Mask Airway Proseal ◽  
Ventilatory Device

scholarly journals Learning Curves for Bag-and-mask Ventilation and Orotracheal Intubation

2010 ◽  
Vol 112 (6) ◽  
pp. 1525-1531 ◽  
Author(s):  
Ryu Komatsu ◽  
Yusuke Kasuya ◽  
Hisanori Yogo ◽  
Daniel I. Sessler ◽  
Edward Mascha ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Failure Rate ◽  
Orotracheal Intubation ◽  
Learning Curves ◽  
Failure Rates ◽  
Mask Ventilation ◽  
Intubation Success ◽  
Intubation Success Rate ◽  
Ventilation Failure ◽  
Bag And Mask Ventilation

Background In this study, the authors determined the success and failure rates for interns learning bag-and-mask ventilation and orotracheal intubation. Their goal was to determine the amount of experience needed to perform these procedures correctly. Methods The authors recorded 695 bag-and-mask ventilations and 679 orotracheal intubations performed by 15 inexperienced interns during their 3 month-long anesthesia rotations. Learning curves for each procedure for each intern were constructed with both the standard and risk-adjusted cumulative sum methods. The average number of procedures required to attain a failure rate of 20% was estimated for each technique. Results Fourteen of 15 interns attained acceptable failure rates at bag-and-mask ventilation after 27 +/- 13 procedures, with a median (95% confidence interval) of 25 (15-32) procedures to cross the decision limit when considering all 15 interns. Nine of 15 interns attained acceptable failure rates at orotracheal intubation after 26 +/- 8 procedures, with a median of 29 (22-not estimable) procedures to cross the limit when considering all interns. The proportion of interns who attained acceptable failure rates for mask ventilation was greater than for tracheal intubation (93% vs. 60%, P = 0.025). Overall, our interns achieved a bag-and-mask ventilation failure rate of 20% or better after a median of 25 procedures; approximately 80% of interns achieved the goal after 35 procedures or less. Conclusions Participating interns developed mask ventilation skills faster than orotracheal intubation skills, and there was more variability in the rate at which intubation skills developed. A median of 29 procedures was required to achieve an 80% orotracheal intubation success rate.

Lightwand Tracheal Intubation with and without Muscle Relaxation

2006 ◽  
Vol 104 (2) ◽  
pp. 249-254 ◽  
Author(s):  
Eva Massó ◽  
Sergi Sabaté ◽  
Marta Hinojosa ◽  
Pere Vila ◽  
Jaume Canet ◽  
...  
Keyword(s):  
Placebo Group ◽  
Tracheal Intubation ◽  
Failure Rate ◽  
Muscle Relaxation ◽  
Orotracheal Intubation ◽  
Muscle Relaxants ◽  
Controlled Study ◽  
Intubation Time ◽  
Double Blind ◽  
Effective Ventilation

Background Lightwand tracheal intubation is a suitable technique for patients who are difficult to intubate but who are receiving effective ventilation. The effect of muscle relaxants on the efficacy of lightwand intubation has not yet been evaluated. The authors conducted a prospective, double-blind, placebo-controlled study to assess the effectiveness and incidence of complications of lightwand tracheal intubation performed during general anesthesia with and without the use of a muscle relaxant in patients with apparently normal airway anatomy. Methods One hundred seventy-six patients who required orotracheal intubation were prospectively included. Anesthesia was administered using propofol (2 mg/kg, then 3 mg . kg (-1). h(-1)) and remifentanil (1 microg/kg, then 0.3 microg . kg(-1) . min(-1)). Patients were randomly assigned to one of two groups (n = 88 for each) to receive rocuronium 0.6 mg/kg or saline intravenously. Lightwand orotracheal intubation (Trachlight; Laerdal Medical Inc., Armonk, NY) was attempted after 3 min. The authors recorded the number of successful intubations, the number of attempts and their duration, and events during the procedure. Results The failure rate of lightwand intubation was 12% in the placebo group and 2% in the rocuronium group (P = 0.021). Patients in the placebo group received more multiple intubation attempts (P < 0.001), required a greater intubation time (77 +/- 65 vs. 52 +/- 31 s; P = 0.002) and experienced a greater incidence of events during intubation (61 vs. 0%; P < 0.001) than patients in the rocuronium group. Conclusions The use of muscle relaxants in patients with apparently normal airways is associated with a lower failure rate, decreased intubation time, and fewer attempts when performing lightwand orotracheal intubation.

Airway management

2007 ◽  
pp. 259-266
Keyword(s):  
Tracheal Intubation ◽  
Respiratory Tract ◽  
Airway Management ◽  
Airway Obstruction ◽  
Failure Rate ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Positive Pressure ◽  
High Failure Rate ◽  
Advanced Airway

Aims of airway management 260 Upper airway obstruction 260 Airway manoeuvres 261 Ventilation 266 • To relieve upper airway obstruction. • To facilitate positive pressure ventilation. • To protect respiratory tract from aspiration of gastric contents. Upper airway obstruction is a commonly encountered emergency and is often relieved by simple basic airway manoeuvres. Although many patients will go on to require more advanced management (e.g. tracheal intubation), such procedures carry a high failure rate and should not be performed by inexperienced practitioners. However, it is still useful to have a good knowledge about advanced airway manoeuvres as it enables the non-anaesthetist to prepare some of the equipment needed and to assist during the procedure once expert help has arrived....

scholarly journals Tracheal Intubation in Out-Of-Hospital Setting is Associated With A High Failure Rate of The First Attempt: A Multicenter Prospective Study

2021 ◽  
Author(s):  
Michel Galinski ◽  
Marion Wrobel ◽  
Romain Boyer ◽  
Paul Georges Reuter ◽  
Mirko Ruscev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Tracheal Intubation ◽  
Adverse Events ◽  
Failure Rate ◽  
Hospital Setting ◽  
Rapid Sequence Intubation ◽  
Intubation Attempt ◽  
National Guidelines ◽  
Increased Risk

Abstract BackgroundTracheal intubation in an out-of-hospital setting is a frequent and potentially difficult procedure. The risk of adverse events increases dramatically with the number of attempts. The failure rate of the first intubation attempt ranges from 5 to 32% and the risk factors are unclear. We evaluated the failure rate of the first intubation attempt in an out-of-hospital setting and identified variables potentially associated with such failure.MethodsThis was an observational prospective multicenter study performed over 17 months and involving 10 prehospital emergency medical units. Airway management for patients who needed tracheal intubation followed the national guidelines. Rapid sequence intubation with a sedative and myorelaxant drugs was systematically performed for spontaneously breathing patients. After each tracheal intubation, the operator was required to provide, by completing a data-collection form, information on operator and patient characteristics and the environmental conditions during the intubation. The primary endpoint was failure of the first intubation attempt.ResultsDuring the study period, 1546 patients were analyzed, of whom 59% had cardiac arrest, and 486 intubations failed on the first attempt (31.4% [95% confidence interval = 30.2–32.6]). A multivariate analysis revealed that the following 7 of 28 factors were associated with an increased risk of a failed first intubation attempt: operator with fewer than 50 prior intubations, small inter-incisor space, limited extension of the head, macroglossia, ear/nose/throat tumor, cardiac arrest, and vomiting. The frequency of adverse events was 13.4% and increased with each additional attempt.ConclusionsThe failure rate of the first attempt was high. Most risk factors could be identified only at the moment of occurrence and were not easily anticipated. Finally, the risk of complications increased with the number of attempts.

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